- UPMC (Seneca, PA)
- …Gives constructive feedback and participates in the nursing peer review process.Mentorship & Professional Development + Enthusiastically precepts students, graduate ... nurses, and new team members. + Identifies learning opportunities in clinical and behavioral situations to enhance care delivery. + Actively supports continuous learning through journal clubs, unit presentations, and sharing relevant research. + Regularly… more
- CenterWell (Harrisburg, PA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... focuses on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR**… more
- Penn Medicine (Philadelphia, PA)
- …sharing with organizational partners the issues, which require their attention. Review survey comments and data and identify opportunities with staff for ... improvement within the program's span of influence. Manage Team and Individual Performance: Drive patient/client loyalty and physician referral by ensuring staff under your supervision understand the UPHS commitment to service, their own work processes, and… more
- CenterWell (Harrisburg, PA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... focuses on excellent service to others. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain Compact Nursing License + A minimum… more
- Quarryville Presbyterian Retirement Community (Quarryville, PA)
- …protocol + Serves as Command Post Operator for the entire community + Review Nursing documentation to ensure completion and accuracy + Assists in the development ... of work assignments on units + Assesses all falls occurring on assigned shift and ensure compliance with QPRC policies + Provides direct nursing care as needed Requirements: + Current and valid RN license in the state of Pennsylvania + Degree from a State… more
- St. Luke's University Health Network (Allentown, PA)
- …medical appropriateness criteria for all urgent and emergent transfers/admissions including review of patients chart to determine treatment plan, medical history, ... reason for admission, and special considerations for patient placement. + Reviews patient insurance to determine appropriateness for transfer and communicates with other departments as necessary to facilitate insurance authorizations if needed. + Initiates… more
- ChenMed (Philadelphia, PA)
- …visits. Once a patient has completed their episode of care management the register nurse (RN) will review patient chart for discharge and conduct final discharge ... The Intensive Community Care Manager (ICCM) is a Registered Nurse (RN) who works with our highest complexity patients,...patient needs and services available in the community or review of their benefits. + Completes individual plan of… more
- CVS Health (Harrisburg, PA)
- …guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on meeting ... projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators,… more
- Prime Healthcare (Bristol, PA)
- …status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. ... in a Health and Human Services field is highly preferred. 2. Utilization Review /Case Management experience is highly preferred. 3. 1+ year of clinical experience in… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... care for appropriate reimbursement. + Work with the physician advisor in review of patient medical records identified by RAC/MIC/QIO and other governmental or… more